The Netherlands is famous for its long-standing “tolerance policy” (known as gedoogbeleid), which permits the sale of small quantities of cannabis in licensed coffeeshops under strict conditions. This unique environment has created a complex landscape for individuals seeking access to cannabis.
A recent cross-sectional survey published in the Journal of Cannabis Research explored this complexity, specifically focusing on individuals who report using non-prescribed cannabis for what they consider to be medicinal purposes.
The survey findings, which detail user-reported experiences and reported barriers to formal treatment, offer a valuable perspective on the necessity of clear, regulated medical pathways, such as those established in the United Kingdom.
Understanding the Dutch Cannabis Landscape
In the Netherlands, there are essentially two distinct methods of accessing cannabis, which operate under very different rules:
- The Tolerated Coffeeshop System: This market is technically illegal, but law enforcement tolerates the sale of small amounts of cannabis (up to 5 grams per person) in licensed coffeeshops, provided they adhere to rules like no sales to minors and no hard drugs. This system is considered an unregulated source for users.
- The Medical Cannabis Program: Since 2003, the Netherlands has had a formal, regulated medical pathway overseen by the Office of Medicinal Cannabis (OMC), part of the Ministry of Health. This program ensures that pharmaceutical-grade cannabis products are grown under strict supervision, tested, and supplied only via prescription at pharmacies.
The survey highlighted the massive difference in scale between these two systems, reporting that the vast majority of adults (93.4%) who stated they used cannabis for medicinal purposes or self-care did so without a doctor’s prescription. This suggests that most reported use occurs outside of the regulated medical framework.
Survey Insights: Reported Motives and Patterns of Use
The researchers of the cross-sectional survey aimed to objectively capture the reported actions and statements of the individuals who use non-prescribed cannabis.
A total of 1,059 participants were included in the analysis. Individuals who used both prescribed and non-prescribed products were included in the study, while those using only prescribed cannabis or commercial cannabidiol (CBD) products were excluded.
Reported Conditions and Reasons for Use
The participants in the study reported using non-prescribed cannabis for a variety of conditions. The most frequently mentioned included:
- Chronic pain (43.5%)
- Sleep disorders (40.2%)
- Clinical depression (35.8%)
- ADHD/ADD (35.3%)
- Post-traumatic stress disorder (27.6%)
- Anxiety disorder (23.4%)
When asked about their motives for choosing the non-prescribed route, respondents frequently stated they were seeking an alternative approach after expressing dissatisfaction with conventional medical treatments. Additionally, many reported that they perceived cannabis as having fewer side effects than traditional pharmaceutical options.
Sourcing
- Participants reported that their cannabis was primarily sourced from coffeeshops or social networks. In fact, the majority of participants reported exclusive use of non-prescribed cannabis for medicinal purposes (94.5%).
- Coffeeshops were the most commonly reported source (67.5%), followed by family or friends (25.3%), home cultivation (24.8%), and dealers (21.3%). More than half of the participants (56.1%) reported coffeeshops to be their main source.
Method of Consumption
- Common reported methods of consumption included smoking and vaporisation. Since this is a non-prescribed route, the dosage, product composition, and method of use are determined by the individual rather than a medical professional.
- Herbal cannabis dominated use, with over 80% reporting use and 71% naming it their main product.
- The majority of participants reported exclusive use of non-prescribed cannabis for medicinal purposes (94.5%).
- Coffeeshops were the most commonly reported source (67.5%), followed by family or friends (25.3%), home cultivation (24.8%), and dealers (21.3%). More than half of the participants (56.1%) reported coffeeshops to be their main source.
- Smoking cannabis with tobacco was the most common (63.8%), followed by sublingual use of cannabis oil (31.8%), smoking cannabis without tobacco (27.9%), and oral consumption (21.3%).
- Most participants reported using cannabis with medium or high THC levels and medium or low CBD levels.
- A significant proportion of participants reported not knowing the THC level (15.4%) or CBD level (29.6%) of their product.
The Crucial Difference: Access Challenges and the UK Standard
The survey highlighted a significant difficulty: participants frequently reported challenges in accessing the formal, prescribed medical system. Many felt that official channels were too complex or that their general practitioners lacked sufficient knowledge to provide proper guidance on the prescribed options.
This finding underscores the fundamental importance of a robust, professional, and accessible regulated pathway.
The UK Approach to Medical Cannabis
In the UK, the approach is strictly medical and specialist-led. Unlike the Dutch system of tolerated sales, medical cannabis in the UK is defined as a prescription only medicine (POM).
The UK model prioritises:
- Specialist Consultation: Access is only granted following an assessment by a doctor listed on the General Medical Council’s Specialist Register.
- Regulatory Compliance: All products must meet stringent quality standards and are dispensed via regulated pharmacies.
- Safety and Monitoring: The use, dosage, and patient progress are continually overseen by the specialist doctor, ensuring the treatment is integrated into a wider care plan.
When considering any medical approach, consultation with a qualified professional is essential. The UK’s regulated pathway ensures that patients who are deemed suitable have access to quality-controlled products under the supervision of a specialist doctor.
When accessing products via a non-controlled route, a Curaleaf Clinic white paper highlights that patients are putting themselves at potential risk from adulterants and naturally contaminating substances such as scheduled drugs, heavy metals, mould, bacteria, and other substances.
Curaleaf Clinic provides consultations with specialist doctors to review your individual health needs and determine whether medical cannabis might form part of a comprehensive, regulated care plan.